Surgical decompression apparatus



Dec. 13, 1938. c. J. FILLING ET AL SURGICAL DEGOMPRESSION' APPARATUS 2Sheets-Sheet; 1

Filed April 8, 1936 1;: I J k nvmvroxs P illm a 57655 L Gar n,J1:

latentecl Dec. 13, 1938 I g UNITED STATES PATENT OFFICE SURGICALDECOMPRESSION APPARATUS Charles J. Pilling, Lansdowne, and Burgess L.Gordon, Jr., Philadelphia, Pa, assignors to The George P. Pilling & SonCompany, Philadelphia, Pa., a corporation of Pennsylvania ApplicationApril 8, 1936, Serial No. 73,292

3 Claims. (Cl. 128275) This invention relates to improvements in surmaybe removed when desired. The upper end gical decompression apparatus forthe displaceof the jar is removably held in place by and ment of airfrom within the pleural cavity in between the side arms of a spring clipl2. The the treatment of persons afflicted with pneumoclip 52 is securedto and projects forwardly from thorax and such other disorders of thelungs the panel 9, and the side'arms of the clip are 5 which permit thepassage of air therefrom into fitted to and embrace the neck l3 of thejar. the pleural cavity. The jar H3 is provided with a cover l4 com- Anobject of the invention is to provide a prising ametal body l5 having arubber cushionnovel and advantageous apparatus for permiting washer l6interposed between it and the top 10 ting and controlling thedisplacement or expulof the jar, and having a downwardly-extendl0 sionof air from within the pleural cavity. ing annular flange H whichsurrounds an out- Another objectis to provide adjustabledewardly-extending an u r fla e 3 011 t e neck vices for regulating theextent to which air is 13 3 position the Cover t n The cove permitted topass from within the pleural cav- M has a post 59 rising fixedly fromthe central l5 ity. part of the body 55 thereof. Slidable Vertically 15Another object is to provide a manometer in on the post i9 is a yoke 2i!having arms 2| association with other parts of the apparatus, whichembrace and extend under op Sides whereby the pressure of air within thepleural of the flange N3 of the neck of the jar. The cavity will beindicated at all times when the D 51 9 a d t y 26 a alined Slots 22 andapparatus is in service. 23 respectively, for the reception of a clamp20 The invention resides in the elements and arm level 24 Which s p vted 01 fulc umed the combinations of them hereinafter described on a pin25 which extends throu h Sides of the and claimed. yoke 28 and throughthe lever 24 and through In the accompanying drawings, illustratingvertical slots 26 in sides of the post l9. The 25 the invention, lever24 is provided with a cam Zl which is con- 25 Figure 1 is a front viewof a decompression structed to engage the bottom wall of the slotapparatus illustrating one form of embodiment 22 and raise the yo 25 e ay t0 the y of the invention. of the cover M and thus cause the yoke tofirmly Figure 2 is a side view thereof. clamp the cover upon-the jarwhen the clamp 30 Figure 3 is a sectional detail, on line 33 of lever 24is moved to the right hand side of the 30 Fig. 2, showing the means forclamping the 010- post l9, as shown in Figs. 1 and 3. When the sure onthe jar. clamp lever 24 is moved to the left hand side of Figure 4 is adetail in section showing a porthe post Hi, the yoke 23 is loweredrelatively to tion of the jar, the closure thereon, and the air the bodyof the cover M the pressure of the tube extending through the closureand into cover upon the jar is removed permitting the 35 the jar, thesection through the clamping means removal of the cover from the jarit].

for the closure being taken on line 4-4 of The l wer p r n f thecontainer r j r 0 Fig. 1. provides a Water receiving and containingspace Figure 5 is a sectional detail of a part of the 28 below the line29 and the upper portion of manometer, on line 55 of Fig. 1. the jar it,above the line 29, provides an air re- 40 Figure 6 is a vertical sectionthrough the air ceiving space Bil. This space SE] is open to thecontrolling valve and portions of the flexible atmosphere through anaperture 3| in the body tubes connected thereto. of the cover M.

Figure '7 is a longitudinal section through the Extending verticallythrough the cover [4 is a means for detachably connecting the needle andmetal tube 32 which also extends through a sup- 45 its flexible tube.porting and guiding bracket or post 33 rising Referring to the drawings,the supporting fixedly from the body l5 of the cover [4. The frame orstructure of the apparatus comprises a lower end portion of the tube 32extends into base board 8 and an upright panel 9 rising fixthe waterspace 28 of the jar l3, and the tube edly therefrom. 32 is slidablevertically within the cover I4 50 Mounted upon the base board 8 is asuitable and post 33 to different positions of adjustment closedcontainer which, as herein illustrated is to raise and lower the lowerend of the tube in the form of a transparent glass jar Ill. The withinwater contained within the space 28. jar l0 rests within a metal cup Hwhich is se- The upper portion of the tube 32 is provided cured upon theboard 8 and from which the jar with a gear rack 34 whose teeth areengaged by 55 the teeth of a small gear wheel 35 fixed on a shaft 36 andlocated between plate-like arms 31 which are formed on or secured to theupper end portion of the post l9 and project forwardly therefrom on therespective sides of the gear rack 34. One end of the shaft 36 extendsoutwardly and has a suitable head or wheel 38 fixed on the outer endthereof, by means of which the shaft 36 may be turned to cause the gearwheel 35 in co-operation with the rack 34, to either raise or lower thetube 32 in accordance with the direction in which the head or wheel 38is turned.

The upper end of the tube 32 terminates in a laterally extending head orarm 39 to which a nipple 46 on the forward end of a flexible rubber tube4| is detachably connected. The tube 4| is in communication with thetube '32 through a passage formed in the head or arm 39 and extendingthrough the nipple 40.

The rearward end of the tube 4| is connected to a lateral projection 42on the upper end of a metal fitting 43 which is secured to the panel 9.The flexibility of the tube 4| and its disposition with relation to thetube 32 and fittings 43 are such as to permit the easy up and downadjustment of the tube 32 relatively to the fixed fitting 43. Thefitting 43 has a horizontal passage 44 in the lower portion thereofwhich extends through projections 45 and 46 on the respective sidesthereof, and the fitting also has a vertical passage 41 therein whoselower end communicates with the passage 44 and whose upper endcommunicates with the tube 4| through the lateral projection 42 on thefitting. The vertical passage 41 is interrupted by a valve 48 which isconstructed to be turned within the fitting 43 and which is providedwith a suitable operating head or handle 49, by means of which the valve48 may be turned to open or close the passage 41 as desired.

One end of a long flexible rubber tube 50 is connected to the projection46 of the fitting 43 and communicates with the passage 44 therein. Theother end of the tube carries a metal fitting 5| having a projectingnipple 52 provided with a threaded base 53 and a ground tapered free endportion 54. The nipple 52 extends into a head which forms the base of atubular needle 56, and which is constructed to be detachably connectedto the nipple 52. The interior of the head 55 is threaded for thereception of the thread 53 of the nipple, and the interior of the headhas a ground tapered seat 5! for the reception of the tapered portion 54of the nipple. The parts of the nipple 52 and head 55 are so relatedthat when the head 55 is screwed tight upon the nipple. 52, the taperedend portion of the nipple will be forced into contact with the seat toform a tight joint between the nipple and the head. The parts justdescribed provide a construction which prevents the accidentalwithdrawal of the head 55 from the nipple 52 when the apparatus is inservice, and in which the needle may be readily detached from thenipple, when desired, by unscrewing the head 55 from the thread of thenipple.

The needle 56 has a pointed free end and it is constructed to be forcedinto the body of the person or patient to be treated until the openpointed end of the needle is in communication with the pleural cavity ofthe patient.

The needle 56 is surrounded by a guard disc 58 carried by a sleeve 59which surrounds and is slidable on the needle and is provided with a setscrew 60 to secure it and its disc 58 to the needle in positions oflongitudinal adjustment thereon. The disc 58 serves as a guard to engagethe body of the patient and prevent the insertion of the needle beyondthe desired point for communication with the pleural cavity.

The projection 45 of the fitting 43 is connected by a flexible tube 6|to a projection 62 on the expanded upper end portion 63 of one limb 64of a U-shaped manometer tube 65 containing a suitable pressureindicating liquid, such as colored water 66. The tube 65 is formed oftransparent glass and it is mounted on a backing plate 67 by means ofbrackets 68, and the plate 61 is secured to the panel 9 of theapparatus. The passage 44 of the fittings 43 communicates with theexpanded portion 63 through the tube 6| and projection 62 and a smallcurled glass tube 69 which extends from a wall 16 which closescommunication between the projection 62 and expanded portion 63 aroundthe tube 69. The expanded portion 63 and the small curled tube 69 serveto prevent the indicating liquid 66 of the manometer from accidentallyentering the tubes 6| and 56 during the handling or tilting of theentire apparatus.

The normal level of the water or other liquid 66 in the manometer tube'65 is at the zero line 1|, and the forward surface of the backing plate6'! is provided with a vertical series of markings l2 uniformly spacedabove and below'the zero line H and also with suitable indicia in theform of numerals progressively increasing in value both upwardly anddownwardly from the zero line 7| and designating the liquid level ineither the limb 64 or the limb E3 of the manometer tube 65 the egree ofair pressure above atmospheric pressure that is present in the tubes 6|and 50' and needle 56, and also in the pleural cavity of the patient,when the apparatusis in service. The limb 13 of the manometer tube 65 ispro vided with an expanded upper end portion 14 whose upper end has ayieldable rubber stopper E5 inserted therein. Extending centrallythrough the stopper 15 is a tube 76 having a slightly contracted lowerend and having a plug 11 inserted into the upper end thereof. The plugTI has an axial opening 18 therein through which a small rod or shaft 19extends. The diameter of the opening 18 is greater than the diameter ofthe rod 19 to permit the free passage of air through the opening. Thelower end of the rod 19 has a head 86 secured thereto and restingnormally on the contracted lower end of the tube 16 and closing the samesave for slight air passages formed by indentations 8| in the head 86.The rod '|9 carries a valve body 82 which rests normally below thebottom of the plug 17 and which is adapted to seat against the bottom ofthe plug and close the opening 78 when the rod '59 is raised.

The purpose of providing the valve 82 and its associated parts is toprevent a sudden increase in air pressure above the manometer liquid inthe limb 13 of the tube 65, such as would be pro- 'duced by the coughingof a patient being treated.

Such sudden increase in air pressure would cause the manometer liquid 66to drive air above the same in the limb 13 out through the tube 16 andpassage 18 and cause such air to impinge against the bottom of the head80 and raises the rod 13 and closes the valve 82 and thus immediatelycloses the opening 18 and prevents further discharge of air from thelimb I3, and, consequently prevents the discharge of any of the liquid66 from the manometer. The expanded upper end 7 portion 14 of the limb13 of the manometer also serves to receive and prevent the accidentaldischarge of the indicating liquid 66 from the manometer during thehandling or tilting of the apparatus.

The operation of the apparatus when it is in service is as follows:

The head 33 is turned to lower the tube 32 well into the water withinthe jar l0, valve 48 is closed, the guard 58 is adjusted to the desiredposition on the needle 56, and the needle is projected into the body ofthe patient to be treated until the pointed open end of the needle is incommunication with the pleural cavity. Air within the cavity then passesthrough the needle 56 and tubes 50 and BI into the manometer 65 and actsupon the liquid 66 and causes it to indicate the degree of theintrapleural pressure. The physician in charge now opens the valve 48 toopen communication between the tubes 50 and El and the tubes M and 32,and the intrapleural pressure then acts upon the water within the tube32, the level of the water within the tube being normally at the line29. If the degree of pressure indicated by the manometer is such that itis desired to reduce the same, the head 38 is turned to raise the tube32 until the air can overcome the water pressure within the tube 32 andpass from the lower end thereof up through the body of water within thejar l exteriorly of the tube. The extent to which the tube 32 projectsinto the body of water within the jar l0 determines the air pressurethat is necessary to overcome the water pressure within the tube 32 topermit the air to escape from the lower end of the tube; and, therefore,it will be understood that by raising the tube the quantity of air thatis permitted to pass from the pleural cavity may be nicely regulated.

By raising the tube 32 and observing the air bubbles discharged from itslower end and observing the changing degrees of pressure indicated bythe manometer, the discharge of air from the pleural cavity may beregulated and controlled until the pressure has been reduced to thedesired extent, whereupon the needle 56 is removed from the body of thepatient.

At any time during the operation of the apparatus, the valve 48 may beclosed to close communication of the tubes 5|] and 6| with the tube 32for an accurate reading of the manometer, or for observing the risingand falling operations of the manometer in accordance with the changesin pressure in the pleural cavity occasioned by the breathing operationsof the patient, or for any other purpose.

We claim:

1. In a surgical decompression apparatus, the combination of a containerproviding a water receiving space, a rigid tube provided with a gearrack, means for slidably supporting said tube with its lower end portionextending into said space, a gear wheel in mesh with said rack, meansoperable to turn said wheel to raise and lower said tube, a bodypenetrating tubular needle, and a flexible tube associated with theneedle and the first named tube and establishing communication betweenthem.

2. In a surgical decompression apparatus, the combination of a jarproviding a water receiving space in the lower portion thereof, a coverupon the jar, means for detachably securing the cover to the jar, arigid tube extending through the cover and into said space, meanscarried by the cover for slidably supporting said tube, means operableto raise and lower said tube, a body penetrating tubular needle, and aflexible tube associated with the needle and the first named tube andestablishing communication between them.

3. In a surgical decompression apparatus, the combination of a jarproviding a water receiving space in the lower portion thereof, a coverupon the jar, means for detachably securing the cover to the jar, arigid tube provided with a gear rack and extending through the cover andinto said space, means carried by the cover for slidably supporting saidtube, a gear wheel in mesh with said rack, means operable to turn saidwheel to raise and lower said tube, a body penetrating tubular needle,and a flexible tube associated with the needle and the first named tubeand establishing communication between them.

CHARLES J. FILLING. BURGESS L. GORDON, JR.

